Dental Medicaid Fraud

The problem is multiplied when dental practices are operated by for-profit corporations, and making money becomes more important than taking care of patients’ real dental needs. Past are the days when you could safely assume a dentist was the one operating a dental practice. Many dental practices today are operated by corporations who hire dentists as employees. Because state law generally requires a dentist to own and operate a dental practice, the corporation will have a dentist pretend to be the one in charge. While it may look like the dentists are making decisions about patient care, the corporate decision makers may actually be the ones calling the shots.

It goes without saying that for-profit corporations exist to make money – literally, they operate “for profit.” So when corporations are in charge of dental practices, they are looking above all for a way to make money.

Medicaid-paid dental services can add up to big money, especially if the volume of patients and procedures is high. Some corporate-operated dental clinics will offer services to low-income families at schools or community centers, sending Medicaid the bill regardless of whether the work was necessary or even performed.

Sometimes dentists or dental assistants find themselves employed in a practice that they know is engaging in fraud. They may know about unnecessary procedures that are being done or be aware that Medicaid is being billed for procedures that aren’t performed. In some cases, dentists have found themselves being pressured to engage in dental Medicaid fraud themselves.

Dental Medicaid fraud is against the law. Filing a claim with Medicaid for dental procedures that are medically unnecessary or that have not been performed is a violation of the federal False Claims Act. Many states also have false claims acts as well, so that perpetrators may face state as well as federal charges for engaging in dental Medicaid fraud.

If you know about an instance of dental Medicaid fraud, you may feel unsure of what to do next. It may help to have someone to talk to about your circumstances and your legal rights – someone who has worked with whistleblowers confronting situations like yours.